Hospital response to psychosocial needs of AIDS inpatients

Compassionate care for HIV-infected persons requires response to psychosocial needs. With no new external funding, Women's College Hospital, a 270-bed urban teaching hospital, provided effective psychosocial services for HIV-infected inpatients by developing a comprehensive policy, educating staff, organizing existing services into a psychosocial support team to provide crisis intervention, and developing liaisons with community AIDS organizations. A retrospective chart review of epidemiologic and psychosocial patient data was carried out for 59 HIV inpatients (58 men, 1 woman) admitted 1987-89. Of the cohort, 91% indicated homosexual contact as the only risk factor. A psychosocial support team contacted 90% of these inpatients. One third (36%) of the patients designated as next of kin individuals who were not legally or biologically related. Approximately 25%-30% made active arrangements for impending death, e.g. wills and funeral plans. Thirteen patients, 22%, died in hospital, and three, 5%, on first admission. Experience showed that psychosocial interventions that focus on human dignity and quality of life, normally seen as elements of palliative care, are critically important from the earliest stages of HIV disease and should not be reserved only for those who are terminally ill.